CAN THIỆP NÚT ĐỘNG MẠCH MÀNG NÃO GIỮA ĐIỀU TRỊ MÁU TỤ DƯỚI MÀNG CỨNG MẠN TÍNH: KỸ THUẬT VÀ CÁC ĐẶC ĐIỂM HÌNH ẢNH TRÊN CHỤP MẠCH SỐ HÓA XÓA NỀN

Abstract

Objective: Describe the endovascular technique of middle meningeal artery (MMA) embolization and imaging features on digital subtraction angiography (DSA) associated with intervention in treating chronic subdural hematoma (cSDH). Materials and methods: A cross-sectional descriptive study on 26 patients with cSDH treated with MMA embolization at the Radiology Department, Viet Duc hospital, from November 2021 to February 2023. Results: All MMAs originated from the maxillary artery. 100% of the MMAs ipsilateral to cSDHs showed cotton wool-like staining and contrast pooling around the distal vasculature. The mean diameters of the MMAs on the hematoma side were statistically significantly larger than those on the non-hematoma side (p = 0.00). Only one patient had a right ophthalmic artery originating from the MMA; 28.8% MMAs anastomosed with the ophthalmic artery via the orbital or meningolacrimal branches; one patient had the left MMA pseudoaneurysm, and one patient had a fistulation between the anterior branch of the left MMA and the diploic vein. Conclusion: The imaging features of the MMA on DSA (cotton wool-like staining, contrast pooling around the distal vasculature) suggested that the cause of the cSDH was bleeding from immature neovessels within the membrane of the hematoma supplied from the MMA. This is the basis of the MMA embolization for treating cSDH. Careful evaluation of MMA anatomy on DSA plays an important role in the interventional strategy to achieve effectiveness and avoid complications.